Venous thromboembolism in patients receiving multimodality therapy for thoracic malignancies.

OBJECTIVE: The rate of venous thromboembolism in patients undergoing multimodality therapy for lung malignancy and the impact of preoperative venous thromboembolism on postoperative outcome have not been analyzed systematically.
METHODS: We performed a retrospective review of all patients undergoing induction therapy before lung resection for non-small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007.
RESULTS: Venous thromboembolism developed in 23 (12.3%) of 186 patients undergoing induction therapy. The venous thromboembolism was diagnosed during induction therapy in 11 patients. The proportion of pulmonary embolism was higher during induction therapy (9/11 patients), whereas deep venous thromboses were observed predominantly postoperatively (7/12 patients) (P = .02). The risk of postoperative complications or death was not increased in patients undergoing surgery despite a preoperative diagnosis of venous thromboembolism. However, the risk of postoperative pulmonary embolism was higher in patients undergoing surgery without insertion of an inferior vena cava filter (1/2 patients vs 0/7 after insertion of an inferior vena cava filter, P = .047). The overall survival was similar between patients with or without venous thromboembolism complications.
CONCLUSION: This study demonstrates that venous thromboembolism events in patients undergoing multimodality therapy for lung malignancies is high and deserves careful consideration. Patients with a venous thromboembolism diagnosis during induction therapy may potentially benefit from a temporary inferior vena cava filter before surgery to limit the risk of recurrent pulmonary embolism. A preoperative diagnosis of venous thromboembolism, however, does not affect early and late outcomes after surgery and should not be viewed as a negative prognostic marker.